title: Diagnostic accuracy of endoscopic ultrasound in pancreatic neuroendocrine tumors: a systematic review and meta analysis.
abstract: OBJECTIVE
  To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.
  
  
  METHODS
  Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model).
  
  
  RESULTS
  Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall's tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ² heterogeneity for all the pooled accuracy estimates was > 0.10.
  
  
  CONCLUSIONS
  EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, USA. srinivaspuli@yahoo.com
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kalva
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
authors.forename: Smitha R
authors.initials: SR
authors.lastname: Pamulaparthy
authors.forename: Micheal D
authors.initials: MD
authors.lastname: Cashman
authors.forename: Norman C
authors.initials: NC
authors.lastname: Estes
authors.forename: Richard H
authors.initials: RH
authors.lastname: Pearl
authors.forename: Fritz-Henry
authors.initials: FH
authors.lastname: Volmar
authors.forename: Sonu
authors.initials: S
authors.lastname: Dillon
authors.forename: Michael F
authors.initials: MF
authors.lastname: Shekleton
authors.forename: David
authors.initials: D
authors.lastname: Forcione
mesh_terms: D016009:Chi-Square Distribution; D019160:Endosonography; D006801:Humans; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging*; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Endoscopic ultrasound; Endosonography; Negative predictive value; Neuroendocrine tumors; Pancreatic mass; Positive predictive value; Sensitivity; Specificity; Ultrasound